Not sure if this is true of the original...but what is odd is that the top third is perfectly straight. The middle third, the text tilts upward (notice less space at top of first and last lines). And the last third the text tilts slightly downwards...however the date does not, but the paragraph text does not. The signature does not.

If this was simply a crooked piece of paper being spewed out by a printer, then the entire thing would be crooked and all the text would be crooked in the SAME direction.

Here, it looks like a cut and paste job was down--and manually with tape or glue--and then the final, but botched up, letter was photocopied. There is no other explanation for the text being straight, crooked going up and then crooked going down and then parts of the lower third being straight while the text in between is crooked.

What a coincidence that the letter says Governor Palin has been a patient there for 17 years which would be the same period of time that Bristol would have been a patient if she had been treated there her entire life.

Doctors do not ever describe women in their 40's as "young healthy women". "Young" is reserved for women in their 20's, perhaps 30's, but is most definitely not a term used to describe women in their 40's.